Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Duke Medical Centre on 30 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. We saw that lessons in relation to these incidents were shared and that action was taken to improve safety in the practice and to prevent a recurrence.

• Risks to patients were assessed and generally well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice used innovative methods to engage with patients. For example, they made use of verbal contracts/agreements between doctor and patient to improve dialogue with, and manage the expectations of a small number of patients.

• The practice had a wider, holistic view of individual and community health and wellbeing. As such they worked closely with a local development trust and voluntary/third sector organisations to support patients with issues such as debt and social isolation.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

The were some areas where the provider should make improvement these being:

• Review the immunity status of staff in relation to measles, mumps, rubella and chickenpox in order to assure themselves that their staff are adequately protected in line with the latest guidance.

• Ensure that there is a current legionella risk assessment and fire risk assessment for the practice, and that identified controls are implemented and monitored.

• Review the coding and recording of adult safeguarding concerns on the patient record to ensure that it is clear to permanent and temporary staff such as locums when a patient has a safeguarding issue.

• Review the clinical audit process in place to ensure that all audits capture sufficient detail as well as recording reflection, analysis and learning.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients expressed their views and were involved in making decisions about their care and treatment. One patient said, “It’s an excellent service.” Another told us, “The staff and doctors all care for you.”

Patients’ needs were assessed and treatment was planned and delivered in line with their individual needs. The eight patients we spoke with commented positively about the service they had received. They told us their treatments were clearly explained by the doctors and nurses and raised no concerns about how they were treated. One patient told us, “They are very professional and very human.”

Patients and staff were protected from the risk of infection because appropriate guidance was available and had been followed within the practice. Patients told us the practice was always clean and well maintained.

Staff received appropriate professional development. We saw staff had accessed various training so they could meet patients’ needs and maintain their skills and competencies.

The practice had a system to assess and monitor the quality of service that patients received. Patients we spoke with told us that they were happy with the service they received.

This practice is rated as Good overall. (Previous inspection November 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

This inspection was an announced comprehensive inspection carried out on 15 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review the systems to track prescriptions through the practice, frequency of emergency medicine checks and access to atropine to keep patients safe.

• Complete an overall health and safety risk assessment of the premises.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice